Provider Demographics
NPI:1881666220
Name:ROGERS, ROBERT B (PA)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:B
Last Name:ROGERS
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:3400 W TECUMSEH RD
Mailing Address - Street 2:STE. 101
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-1810
Mailing Address - Country:US
Mailing Address - Phone:405-360-6764
Mailing Address - Fax:405-360-6769
Practice Address - Street 1:13401 N WESTERN AVE
Practice Address - Street 2:STE. 301
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-1408
Practice Address - Country:US
Practice Address - Phone:405-478-7111
Practice Address - Fax:405-360-6769
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2018-11-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK1242363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200003100AMedicaid
OKP00008411OtherRAILROAD MEDICARE
OKOK401541Medicare PIN
OKP76063Medicare UPIN
OK242303701Medicare PIN